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General NPI Number Information
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NPI Number | 1093212375
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Entity Type | Individual
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Provider Name | PUJA MEHTA MD
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Gender | Female
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Dates
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Enumeration Date | 04/12/2018
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Last Update Date | 12/23/2021
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Provider Practice Location Address
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Address Line | 1080 PEACHTREE ST NE STE 12
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City | ATLANTA
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State | GA
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Zip | 30309-6857
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Country | US
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Telephone | 404-253-3660
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 102321
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City | ATLANTA
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State | GA
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Zip | 30368-2321
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 88950
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License Number State | GA
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